急症产科子宫切除术知情同意的分析

为保留产妇的生命权而牺牲其生育权的子宫切除术,仍是控制产科出血的最后手段.产科急症时,患者本人无法做出意思表示,子宫切除术的知情同意权由其法定代理人行使.子宫切除围术期,实施知情同意,仍存在许多法律盲点及实践困难.本文阐述了产科子宫切除术告知的法律义务、行为主体,以及告知患者子宫切除的方式.     

急症产科子宫切除术知情同意的分析

为保留产妇的生命权而牺牲其生育权的子宫切除术,仍是控制产科出血的最后手段。产科急症时,患者本人无法做出意思表示,子宫切除术的知情同意权由其法定代理人行使。子宫切除围术期,实施知情同意,仍存在许多法律盲点及实践困难。本文阐述了产科子宫切除术告知的法律义务、行为主体,以及告知患者子宫切除的方式。     

由产科医疗纠纷司法鉴定案例谈医疗过失的判定

医疗纠纷严重影响社会的和谐与稳定,已成为政府和公众关注的焦点之一.由于产科急症多,妊娠分娩过程的复杂易变,加之家属对产妇的安全分娩及胎儿的安全出生期望值极高等原因,目前产科医疗纠纷占各级医疗机构医疗纠纷的首位.通过产科医疗纠纷司法鉴定案例的介绍,使产科医师了解医疗过失行为的判定以及医疗行为与损害后果的相关度,从而在临床思维和医疗行为方面得到启示,工作中严格履行注意义务,最大限度地降低产科医疗纠纷的发生率.     

剖宫产率上升的原因及对策

近年来,剖宫产率日益上升,严重影响母婴利益,作为教学医院,也影响产科的临床教学质量.为提高产科质量,确保母婴安全,我们通过回顾性分析发现,胎儿窘迫,胎位异常,巨大儿,社会因素是剖宫产率上升的主要原因.相应对策可以通过加强孕产期宣教,实行镇痛分娩,建立待产、分娩、恢复及产后为一体(labor-delivery-recovery,LDR)分娩模式,提高医护人员助产技术水平,健全法制建设等措施,旨在降低剖宫产率.     

剖宫产泛滥的原因及解决对策

剖宫产术经过几代产科医生们的不懈努力得到了不断的发展,成为产科学中一种常见而十分重要的手术,用于帮助不能或不宜经阴道分娩的产妇娩出胎儿,挽救了无数产妇和胎儿的生命。但近20~30年来,世界各地及我国的许多大、中、小城市出现了剖宫产率不断升高的现象。欧美国家的剖宫产     

剖宫产率上升的原因及对策

近年来,剖宫产率日益上升,严重影响母婴利益,作为教学医院,也影响产科的临床教学质量。为提高产科质量,确保母婴安全,我们通过回顾性分析发现,胎儿窘迫,胎位异常,巨大儿,社会因素是剖宫产率上升的主要原因。相应对策可以通过加强孕产期宣教,实行镇痛分娩,建立待产、分娩、恢复及产后为一体(labor-delivery-recovery,LDR)分娩模式,提高医护人员助产技术水平,健全法制建设等措施,旨在降低剖宫产率。     

诺舒阻抗与宫腔镜两种子宫内膜切除术的比较研究

探讨诺舒阻抗子宫内膜切除术在月经过多患者中的临床应用及优越性。将我院2010年1月至2014年5月行诺舒阻抗子宫内膜切除术的57例患者,纳为治疗组。同期宫腔镜单极子宫内膜切除术的45例患者,纳为对照组,比较两组患者术中情况及术后随访各项指标。发现治疗组的手术时间、术中出血量、膨宫液吸收量、电解质紊乱、术后阴道出血时间、阴道排液时间、宫腔积血、宫腔粘连、药物辅助治疗、再次手术（全子宫切除术）均低于对照组,组间对比有统计学意义（P〈0．05）。诺舒阻抗子宫内膜切除术具有学习曲线短、手术易掌握、操作安全、疗效肯定的优点,是目前子宫内膜切除术的首选方法。     

剖宫产瘢痕部位妊娠的相关问题与临床思考

剖宫产瘢痕部位妊娠(CSP)随剖宫产率的增加逐渐成为常见病和多发病。经阴道三维彩超是目前诊断CSP的主要辅助检查。可在局部或全身应用甲氨蝶呤(MTX)控制后选择清宫术、宫腔镜下妊娠物清除术、妊娠物清除术及子宫瘢痕修补术、子宫动脉栓塞术等治疗方案,同时可以将多种方案结合,以达到优化治疗。对于计划妊娠的CSP需要根据临床症状、孕周、胚胎情况、子宫肌层厚度及患者的意愿来综合考虑,进行人性化与个体化管理,必须和患者充分沟通,告知风险。倡导自然分娩,杜绝无医学指征剖宫产才是从根本上降低CSP的发生。     

自由体位分娩与传统分娩方式在产程管理中的对比分析

观察自由体位分娩过程中采用新的产程管理对分娩结局的影响。将符合要求的孕妇随机分为试验组及对照组各124例,试验组采取自由体位分娩,按照新的产程标准管理;对照组采用平卧位分娩,按现行产程标准管理。试验组第1、2产程及总产程较对照组明显延长,差异有统计学意义(P0.05);试验组顺娩122例,中转剖宫产2例,对照组顺娩94例,剖宫产30例,差异有统计学意义(P0.001);两组孕妇产后出血量、会阴裂伤、肩难产、新生儿窒息率等均差异无统计学意义(P0.05)。应用新的产程管理,显著降低了剖宫产率,但并未增加母儿不良结局。     

妇科腹腔镜手术后输尿管阴道瘘的诊治策略

探讨妇科腹腔镜手术后输尿管阴道瘘的诊治策略。选取笔者所在科室收治的17例妇科腹腔镜手术后输尿管阴道瘘患者,其中1例合并膀胱阴道瘘。其中行腹腔镜子宫切除3例,腹腔镜广泛子宫切除加盆腔淋巴结清扫13例,腹腔镜子宫阔韧带肿瘤切除1例。患者均表现为阴道有液体不自主流出,发生于术后6天~21天,平均10.8天。伴腹痛9例,发热3例。就诊时间为出现尿液漏出第3天~30天,平均13.3天。结果 8例行输尿管镜下留置双J管,治愈5例。12例行输尿管膀胱再植术,均治愈。妇科腹腔镜手术后输尿管阴道瘘一经诊断明确,需及时行输尿管镜探查,可选择合适患者行留置输尿管支架管治疗。     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.